Answer: <p><strong>Management of male infertility </strong></p>
<ol>
<li><strong>General measures</strong></li>
</ol>
<ul>
<li>Education of sexual counseling as coital frequency and timing at a fertile period, coital position, and avoidance of masturbation as this leads to sperm dilution.</li>
<li>Improvement of general health including reduction of weight in obese patient.</li>
<li>Avoidance of alcohol and heavy smoking.</li>
<li>Avoidance of tight and warm undergarments, use of cold scrotal bath at least twice a day for 5 minutes.</li>
<li>Avoidance of too frequent intercourse may improve the sperm count.</li>
<li>Avoid strenuous activities, occupation in hot environment etc.</li>
<li>Prompt correction of Diabetic and Thyroid problem</li>
<li>The use of vitamin E, C, B12 and Folic acid also improve spermatogenesis and toxic free radicals, released by abnormal sperm and leukocyte present in the semen.</li>
</ul>
<ol start="2">
<li><strong>Treatment of genital tract infection</strong>: use of appropriate antibiotics to treat epididymo-orchitis, prostatitis, and sexually transmitted disease.</li>
<li><strong>Management of hypogonadotropic-hypogonadism (endocrinal correction</strong>): the disorder of spermatogenesis can be treated with the following therapy with varying degree of success.</li>
</ol>
<ul>
<li>Clomiphene citrate for reduced or low gonadotrophins</li>
<li>HCG 5000 IU IM once or twice weekly is given to stimulate endogenous testosterone production.</li>
<li>HMG or HCG are used in case of gonadotrophin deficiency or failed clomiphene citrate cases.</li>
<li>Use of GnRH administered by minipump infusion for hypothalamic dysfunction.</li>
<li>Bromocriptine for hyperprolactinemia.</li>
</ul>
<ol start="4">
<li><strong>In retrograde ejaculation:</strong> phenyl ephrine is used to improve the tone of an internal urethral sphincter.</li>
<li>In the presence of anti-sperm antibodies in the male dexamethasone 0.5mg daily at bedtime may be useful.</li>
<li><strong>Artificial insemination of husband:</strong> Artificial insemination by husband (AIH): A procedure in which a fine catheter (tube) is inserted through the cervix (the natural opening of the uterus) into the uterus (the womb) to deposit a sperm sample from the woman's mate directly into the uterus. The purpose of this procedure is to achieve fertilization and pregnancy. AIH is distinguished from artificial insemination by donor (AID) in which a donor is a man other than the woman's mate. AIH is also known as homologous insemination.</li>
<li><strong>Surgical management</strong></li>
</ol>
<ul>
<li>Obstruction of vas deference may correct by epididymectomy or vaso-vaso anastomosis.</li>
<li>The presence of varicocelo is corrected by high ligation of spermatic vein and the hydrocele by surgery.</li>
<li>Orchidopexy in undescended teste should be done between 2-3 years to have adequate spermatogenesis in later life.</li>
</ul>
<ol start="8">
<li>Assisted reproductive technology</li>
</ol>

Answer: <p><strong>Management of female infertility</strong></p>
<p>The treatment modalities in female infertility are grouped as follows according to the disorders:</p>
<ol>
<li><strong>Ovular factors</strong></li>
<li>Induction of ovulation</li>
</ol>
<p>Ovarian stimulation with clomiphene citrate alone or along with various combinations has been commonly practiced.</p>
<ul>
<li>Clomiphene citrate (50/100/150mg) daily from D3 to D7 and injection hCG (5000 IU) at the time of LH surge.</li>
<li>Clomiphene citrate 950/100/150mg) daily from D3 to D7 + inj. HMG (75IU) from D3 to D7 + inj. HMG ((75IU) from D8 to D10 followed by injection hCG (55000IUU) at the time of LH surge.</li>
</ul>
<ol>
<li>Intra-uterine insemination: during IUI a prepared semen sample with adequate numbers of motile normal sperms suspended in a nutrient medium are directly placed in the uterine cavity, thus by passing the need for sperms to travel from the vagina to the uterus. This is done at the predicted time of ovulation. Insertion should be done with either the husband&rsquo;s semen or from a donor.</li>
<li><strong>Tubal/peritoneal factors</strong></li>
</ol>
<p>The possible tubal factors causing infertility includes:</p>
<ul>
<li>Peritoneal adhesion</li>
<li>Inflammatory endosalpingeal damage</li>
<li>Tubal occlusion by infection or sterilization</li>
</ul>
<p>Tuboplasty or microsurgical techniques is commonly used a surgical procedure, which includes adhesiolysis, fibrinolysis, salpingostomy, tubo-tubal anastomosis, tubo-cornuaal anastomosis.</p>
<p>Adjunctive procedure to improve the result of tubal surgery includes prophylactic antibiotic, intraoperative instillation of RL alone or mixed with heparin or hydrocortisone or postoperative hydrotubation.</p>
<ol start="3">
<li><strong>Cervical factors</strong>: cervical mucus protects sperm from the hostile environment of the vagina and also from phagocytosis. The cervical mucus quality can be improved by weak alkaline douching or conjugated estrogen 1.25 mg orally in the follicular stage.</li>
<li><strong>Immunological factors</strong>: dexamethasone 0.5mg at bedtime for anti-sperm antibodies in the cervical mucus in the follicular phase. It may reduce anti-sperm antibodies and therefore facilitate sperm penetration. Couple should encourage regular intercourse during the fertile period. If not improved intrauterine insemination with washed sperm is an alternative.</li>
<li>Unexplained infertility: it is strange that 4 out of 10 couples become pregnant within 3 years without having any specific treatment. Because of spontaneous cure rate, one should wait for certain times before employing ART, IUI, IVF or other methods.</li>
<li><strong>Assisted reproductive technology (ART</strong>) is the technology used to achieve pregnancy in procedures such as fertility medication, artificial insemination, in vitro fertilization and surrogacy. It is reproductive technology used primarily for infertility treatments and is also known as a fertility treatment. It mainly belongs to the field of reproductive endocrinology and infertility, and may also include intra cytoplasmic sperm injection (ICSI) and cryopreservation. Some forms of ART are also used with regard to fertile couples for genetic reasons (pre-implantation genetic diagnosis). ART is also used for couples who are discordant for certain communicable diseases; for example, HIV to reduce the risk of infection when a pregnancy is desired.</li>
</ol>